The potential benefits of the PPCR are varied and great, including the ability to identify referral patterns, evaluate the efficacy of protons for disease control, and better evaluate late effects outcomes. An invitation to subsequently-opening proton centers will be extended to the pediatric provider, director, or chair as long as sufficient funding for this project is available.
Louis, MO, USA), Indiana University Health Proton Therapy Center (Bloomington, IN, USA), Mayo Clinic - Rochester (Rochester, MN, USA), Hampton University (Hampton, VA, USA), ProCure Proton Therapy Center - Oklahoma City (Oklahoma City, OK, USA), Mayo Clinic - Arizona (Scottsdale, AZ, USA), ProCure Proton Therapy Center - New Jersey (Somerset, NJ, USA), Loma Linda University (Loma Linda, CA, USA), Rutgers Cancer Institute of New Jersey (New Brunswick, NJ, USA), and the Provision Center for Proton Therapy (Knoxville, TN, USA). The current members include Massachusetts General Hospital (MGH Boston, MA, USA), MD Anderson Cancer Center (Houston, TX, USA), University of Pennsylvania (Philadelphia, PA, USA), University of Florida Proton Therapy Institute (Jacksonville, FL, USA), CDH Proton Center (Warrenville, IL, USA), Washington University (St.
For this reason, the Pediatric Proton Consortium (PPC) has been created to unify and share the experiences of pediatric proton therapy centers across the United States. Furthermore, the United States lacks a comprehensive profile of pediatric patients being referred for and ultimately receiving protons. Nevertheless, because of the relative rarity of pediatric cancers, accumulating the appropriate data is an expensive and prolonged process that impedes the timely and necessary comparison of proton outcomes to existing photon data on late effects. Many of these proton therapy centers conduct single-institution research and participate in Children's Oncology Group trials. It is widely accepted within the radiation oncology community that protons have great potential to reduce the late effects of treatment in the pediatric population. There are currently 13 operating proton centers in the United States and many more are opening imminently. Therefore, proton therapy dose distributions are usually superior to those of photon therapy by a factor of 2 or greater allowing the potential to further improve clinical outcomes by specifically decreasing toxicity associated with treatment. Unlike photon radiation, which entails both an entrance and exit dose to normal tissues in the process of treating a tumor in a given beam line, proton radiation entails a somewhat lower entrance dose and eliminates exit dose to normal tissues. The most widely available form of particle therapy is proton therapy, and its dose distribution in most cases is superior to that which can be achieved with even the most sophisticated photon techniques. Particle-beam radiation therapy is a newly recognized modality of radiation that is being harnessed to further improve the dose localization to the target and to better spare normal tissues. There have been tremendous advances in radiation therapy delivery that have had a remarkable impact on its delivery, including better immobilization for reproducible treatment, better imaging for target delineation, and improved delivery techniques with intensity modulation.
The current focus in radiation oncology is to improve dose localization to the target, which allows for dose escalation, if required, and lower toxicity profiles. Radiation therapy to pediatric cancer patients exacts a late-effects toll that is inversely proportional to age at radiation therapy yet directly proportional to volume of tissue irradiated and radiation dose. The Childhood Cancer Survivor Study (CCSS) has successfully catalogued the late effects of treatment and published seminal articles on how radiation therapy and chemotherapy treatments have adverse effects on childhood cancer survivors. There is a dual focus of pediatric cooperative groups continuing to cure children at high rates while diminishing the late side effects and morbidities associated with the treatment.
Today, nearly 80% of childhood cancer patients are long-term survivors.
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